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Clinical predictors of gleason score upgrading
Author(s) -
Kulkarni Girish S.,
Lockwood Gina,
Evans Andrew,
Toi Ants,
Trachtenberg John,
Jewett Michael A. S.,
Finelli Antonio,
Fleshner Neil E.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22712
Subject(s) - medicine , nomogram , prostatectomy , prostate cancer , watchful waiting , logistic regression , prostate specific antigen , rectal examination , biopsy , brachytherapy , cohort , high grade prostatic intraepithelial neoplasia , prostate , stage (stratigraphy) , cancer , intraepithelial neoplasia , oncology , urology , radiation therapy , biology , paleontology
BACKGROUND Brachytherapy, active surveillance, and watchful waiting are increasingly being offered to men with low‐risk prostate cancer. However, many of these men harbor undetected high‐grade disease (Gleason pattern ≥4). The ability to identify those individuals with occult high‐grade disease may help guide treatment decisions in this patient cohort. METHODS The authors identified 175 cases of low‐risk prostate cancer treated with radical prostatectomy. By using logistic regression analysis, 11 a priori‐defined preoperative risk factors were evaluated for their ability to predict upgrading from Gleason 6 at biopsy to Gleason ≥7 at radical prostatectomy. An internally validated nomogram using all clinical variables was subsequently created to help physicians identify patients who had undetected high‐grade disease. RESULTS A total of 60 (34%) patients were upgraded to high‐grade disease. On multivariate analyses, both prostate‐specific antigen (PSA) level ( P = .02) and the level of pathologist expertise ( P = .007) were predictive of upgrading. The predictive nomogram contained these variables plus age, digital rectal examination, transrectal ultrasound results, biopsy scheme applied (sextant vs extended), presence of prostatic intraepithelial neoplasia, prostate gland volume, and percentage of cancer in the biopsy. The nomogram provided acceptable discrimination (C statistic 0.71). CONCLUSIONS The authors identified significant predictors of upgrading for patients diagnosed with low‐risk prostate cancer. A nomogram based on these study findings could help physicians further risk‐stratify patients with low‐risk prostate cancer before embarking on treatment. Caution should be exercised in recommending nonradical therapy to individuals with a high probability of undetected high‐grade disease. Cancer 2007. © 2007 American Cancer Society.